"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

May 24, 2019

Health officials in five states have warned people believed to be infected with measles and planning to travel that they could prevent them from getting on planes.

All eight individuals agreed to cancel their flights after learning the officials could ask the federal government to place them on a Do Not Board List managed by the Centers for Disease Control and Prevention, said Martin Cetron, director of the agency’s Division of Global Migration and Quarantine, which tracks disease outbreaks.

“The deterrent effect is huge,” he said.

CDC officials said the agency had been contacted about the individuals by health officials in New York, California, Illinois, Oklahoma and Washington.

The government’s travel ban authority often gets little discussion “because it is a politically charged and politically visible request,” said Lawrence Gostin, a professor of global health policy at Georgetown University.

Though less restrictive than isolation or quarantine, the public health measure “is seen as a government using its power over the people and the states, which is kind of toxic in America right now,” said Gostin. “There is nothing unethical or wrong about it. It’s just plain common sense that if you have an actively infectious individual, they should not get on an airplane.”

Health officials emphasize that vaccination is the best and most effective way to protect against measles, and that the majority of people with infectious, communicable diseases, like measles, listen to doctors’ advice not to travel.

Officials in Rockland County, N.Y. and New York City, the epicenter of measles outbreaks since last fall, say they have advised several infected individuals against traveling.

Earlier this spring, Rockland health officials, who have had 238 measles cases since last October, consulted with CDC about placing two infectious individuals on the list to prevent them from flying to Israel for the Passover holiday, a county spokesman said.

“It served as an effective deterrent,” said spokesman John Lyon. “They did not travel."

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Tuesday, May 21, 2019

The epidemiological situation of the Ebola Virus Disease dated May 20, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,847, of which 1,759 are confirmed and 88 are probable. In total, there were 1,223 deaths (1,135 confirmed and 88 probable) and 487 people healed.

• 292 suspected cases under investigation;

• 21 new confirmed cases, including 5 in Beni, 5 in Kalunguta, 4 in Butembo, 4 in Musienene, 2 in Mabalako and 1 in Masereka:

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Butembo and 1 in Musienene;

º 2 deaths at the CTE of Beni;

• 3 new healed CTE patients, 2 in Butembo and 1 in Katwa;

• One health worker in Masereka, vaccinated, is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 104 (5.6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Operations of the response

• On the sidelines of the 72nd World Health Assembly (WHA) in Geneva, the Minister of Health, Dr. Oly Ilunga, the WHO Director General, Dr Tedros Adhanom Ghebreyesus, and the Director of the WHO Regional Office in Africa (AFRO), Dr Matshidiso Moeti, reported on the evolution of the Ebola outbreak and regional preparedness activities at a meeting of AMS Committee A on Tuesday 21 May 2019.

• All stakeholders recognized that the main barrier to ending this epidemic is the security context and violence against the response teams. The Minister of Health recalled that, from the point of view of public health, Ebola virus disease is not a particularly difficult disease to contain, especially since the country currently has a diagnostic, therapeutic medical arsenal and comprehensive preventive for the first time in the history of the virus. He recalled that to break the chain of transmission, it is enough to do a series of important activities around the confirmed cases, dead or alive, in particular the sensitization, the epidemiological investigations, the disinfection of the household, the vaccination and the follow-up of the contacts, and funerals worthy and secure. All these activities are available but teams are sometimes prevented from doing them because of insecurity or mistrust of the population. The Director of WHO emphasized that the Ebola epidemic in the DRC is still ongoing, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic, not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic. not because the teams do not have the means or the skills but because they can not get regular access to the sick in the communities. If the security environment improves and access to communities is guaranteed, the response teams will be able to put an end to this epidemic.

• While welcoming the work of the Congolese Government in containing the Ebola outbreak, the Director of WHO-AFRO presented the progress of regional preparedness in case the Ebola outbreak spreads outside the DRC. To date, no cases of Ebola have been detected in DRC's neighboring countries thanks to the efforts of the Government and partners, who have examined more than 50 million travelers at the various health checkpoints located east of the DRC. country. As part of the regional preparedness plan, the nine countries bordering the DRC now have an emergency plan, 16 Ebola treatment centers have been built in neighboring countries, 270 technical experts have been deployed to support the efforts of border countries.

FIGURES OF THE RESPONSE

121,202 vaccinated persons

• 564 people vaccinated on 20/05/2019.

• Of those vaccinated, 33,118 are high-risk contacts (CHR), 59,281 are contacts of contacts (CC), and 28,803 are front-line providers (PPL).

• Persons vaccinated by health zone: 32,126 in Katwa, 24,788 in Beni, 15,069 in Butembo, 9,208 in Mabalako, 6,021 in Mandima, 4,235 in Kalunguta, 3,070 in Goma, 3,048 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,972 in Lubero , 1,945 to Masereka, 1,935 to Vuhovi, 1,817 to Kyondo, 1,487 to Bunia, 1,558 to Musienene, 1,357 to Karisimbi, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 494 to Alimbongo, 420 to Mambasa, 355 to Tchomia, 342 to Kirotshe, 333 to Lolwa, 250 to Mweso, 245 to Kibirizi, 161 to Nyiragongo, 97 to Watsa (Haut-Uélé) and 13 to Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

There was a steady increase in the number of Ebola virus disease (EVD) cases reported during this week in the Democratic Republic of the Congo. The past week was marked by a relative decrease in the number and severity of security incidents, and most response activities were conducted as planned.

However, despite this short lull, the situation remains highly unpredictable, as threats against EVD response teams and facilities continue to be received, especially in the Butembo/Katwa hotspot. As such, further attacks or attempted attacks remain likely in the short term. Additionally, in line with the trend observed in the previous few weeks, armed groups’ presence, activities, and increasing direct threats against EVD response teams (leaflets and intimidation of local health workers collaborating with response teams) continue to be reported in Lubero, Kalunguta, Mabalako, Masereka, and Komanda.

Another particularly concerning development is that some healthcare workers are refusing to wear personal protective equipment and clothing in healthcare facilities, and performing only normal infection prevention and control measures due to threats of violence by members of the community.

Community members in hotspot areas such as Katwa, Mandima, and Mabalako reportedly continue to feel frustrated by the outbreak response, as indicated in the latest community feedback.

However, the Ministry of Health (MoH), WHO, and partners remain committed to strengthening community engagement efforts to help address their feedback, encourage greater participation and ownership of various response activities, and urge individuals suspected to have contracted EVD to proactively engage with response workers and to seek care early in order to improve their chances of survival, as well as to reduce the risks of transmission in the community.

Meanwhile, an Infection Prevention and Control (IPC) campaign is currently in progress at four healthcare facilities in Butembo and Katwa. The campaign is promoting key messages for healthcare workers to aid in stopping transmission of EVD within healthcare facilities, specifically addressing hand hygiene and the importance of safe injections. Activities will be in place throughout the week to promote IPC in these facilities.

This week, week ending 19th May, a total of 121 new confirmed cases were reported this week. Most of these cases originated from hotspot areas within the Mabalako, Beni, Butembo, Kalunguta, Katwa, Mandima and Musienene, health zones. In the 21 days between 29 April to 19 May 2019, 86 health areas within 16 health zones reported new cases, representing 48.6% of the 177 health areas affected to date (Table 1 and Figure 2). During this period, a total of 338 confirmed cases were reported, the majority of which were from the health zones of Katwa (22%, n=75), Mabalako (18%, n=62), Butembo (13%, n=44), Beni (11%, n=36), Kalunguta (10%, n=33), Mandima (9%, n=32) and Musienene (9%, n=31).

Cumulatively, as of 19 May 2019, a total of 1826 EVD cases, including 1738 confirmed and 88 probable cases, were reported. A total of 1218 deaths were reported (overall case fatality ratio 67%), including 1130 deaths among confirmed cases. Of the 1826 confirmed and probable cases with known age and sex, 54% (993) were female, and 30% (540) were children aged less than 18 years. The number of healthcare workers affected has risen to 102 (6% of total cases).

Hospitals are losing an important public relations battle over the expanding threat of superbugs, including the deadly fungus Candida auris. Though states are tasked with conducting outbreak investigations, they aren't required to disclose their findings to the Centers for Disease Control and Prevention (and in many cases they haven’t). Grieving families are pushing for more transparency, while patient advocates smell a cover-up, likening the scenario to a restaurant failing to report an outbreak of food poisoning. In the midst of all this mistrust, hospital spokesmen are declining to comment. This is a mistake.

I hate to be the bearer of bad news, but these microbes are in our homes, cars and grocery stores. One study found that even after the use of disinfectant, more than half of hospital rooms still contain a superbug. Nurses and doctors carry these things around, too. Roughly 5 percent of health care workers are colonized with MRSA, a bacterium that kills thousands of people in the United States every year, and another study found that 10 percent of patients entering a hospital had a multidrug-resistant species on their hands. You don’t want to know what’s hiding on a handkerchief.

Here’s the thing: You almost certainly don’t need to worry about any of this. Potentially deadly bacteria and fungi live harmlessly on our hands, feet, and faces, and may never cause a problem. There are trillions of bacteria living inside all of us. Why are we pretending they aren’t on our gurneys, blood pressure cuffs and X-ray machines?

Demanding that hospitals release lists of every superbug they find within their walls, however, as many transparency advocates want, is not the answer. The irony is that the hospitals that see the most superbugs are often the best ones we have, for the simple reason that they have the most sophisticated diagnostic platforms, the most powerful antibiotics and the experts to administer them.

Compelling a world-class hospital like Massachusetts General Hospital, where I saw my first superbug as a medical student, to reveal a microbe list would only freak patients out. It wouldn’t explain where the microbes came from, whether any patients were infected, and how they were cured.

In a worst-case scenario, more transparency could lead to patients avoiding medical care out of a misplaced fear of encountering drug-resistant bacteria. Hospitals might start refusing patients with certain infections, especially those coming from nursing facilities where these microbes are common, out of a concern that the patient’s bacteria could be added to the list. This would do everyone a disservice: Patients wouldn’t receive optimal care and superbugs would multiply.

But hospital administrators and government officials do need to be honest about the microbes in our medical centers and explain what is really going on. No comment will no longer suffice. People have questions and this story is not going away. To ensure that patients are well-informed, hospitals should train spokesmen to address these issues and states should revisit their reluctance to disclose information. Above all, health care workers and administrators should speak openly about the measures their hospitals are already employing to keep people safe.

I’m not particularly interested in the microbes that dwell inside of a given hospital; what matters is whether its employees follow the strict protocols that prevent these organisms from going where they shouldn’t.

Dr. Michael Ryan, Executive Director of the WHO Health Emergencies Program, has just completed a two-day mission to Butembo, one of the areas affected by the Ebola outbreak in the DRC. It describes a delicate situation, made even more complicated by the activities of armed groups and the resistance of local communities.

Among the main obstacles to the response to the Ebola epidemic in the DRC, Michael Ryan, Executive Director of the WHO Health Emergencies Program, first described an increasingly difficult security environment.

"It's not possible to stop Ebola in such a situation of community-level tensions, political manipulation, and all armed groups. The situation on the ground is not calm enough for public health operations, "he said.

On Saturday, the Ministry of Health reported that the head of the safe burial team had been attacked in Bunia. Another team suffered the same fate in Butembo on Friday.

This difficult environment is forcing teams to start over, as Michael Ryan has seen. "The problem now is reinfection of the areas. We stopped the transmission to Beni, we stopped the transmission to Mangina, Mabalako, but we still have a little transmission, "he notes.

The other challenge is contamination even in the treatment centers. "We must stop, absolutely stop transmission in health facilities, pleaded the executive director of the WHO. This is a disaster, it is a real tragedy to have transmissions in the very places where people go for care."

Since the beginning of the epidemic, 102 health workers have been infected; 34 have died.

Recurring mechanisms

Resistance to the response has made the epidemic more and more deadly. In the sector of Beni-Butembo, more than 200 people succumbed to the virus in a fortnight. According to the latest WHO figures, since the beginning of the epidemic in the DRC, there have been nearly 1,150 deaths for more than 1,700 confirmed and probable cases.

This is not the first time that there has been such resistance to the response. In West Africa, for the Ebola outbreaks between 2013 and 2015, this was also the case. There had been misinformation campaigns, attacks on health centers and even staff.

The American anthropologist Adia Benton worked on these epidemics. "It happened in Liberia and Sierra Leone in areas where there was already mistrust of the people towards the government," she says. Some people really believed that the information that was given about Ebola was false or was part of a conspiracy that targeted them personally."

May 16, 2019

Although the security situation has subsided mildly into an unpredictable calm, the transmission of Ebola virus disease (EVD) continues to intensify in North Kivu and Ituri provinces with more than 100 confirmed cases reported this week.

The main drivers behind the continued rise in cases stems from insecurity hampering access to critical hotspot areas, persistent pockets of poor community acceptance and hesitation to participate in response activities, and delayed detection and late presentation of EVD cases to Ebola Treatment Centres (ETCs)/Transit Centres (TCs).

Of particular concern are the community deaths resulting from the culmination of these factors. Community deaths denote all EVD (confirmed and probable) cases who died outside of an ETC/TC. This includes cases who die at home, as well as those who die within public/private hospitals and other health centres. On average, community deaths comprise approximately 40% of cases reported each week. This proportion fluctuates on a weekly basis, ranging from 28% to 43% of cases since the beginning of April after peaking as high as 71% in February. Of the total deaths (1147) currently listed in surveillance systems, approximately two thirds (68%) occurred outside of ETCs. Many of the patients who arrive at ETCs, often do so in a severe condition with a poor prognosis, and subsequently die shortly after admission.

Community deaths also pose a major transmission risk as these cases have spent more time in the community while symptomatic and remain highly infectious at the time of their death and thereafter; propagating EVD to other members of the community such as family members and healthcare workers.

Despite the continued increase in EVD cases, it should be noted that transmission remains most intense in seven main hotspot areas: Katwa, Mabalako, Mandima, Butembo, Musienene, Kalunguta, and Beni. Collectively, these health zones account for the vast majority (93%) of the 350 cases reported in the last 21 days between 24 April – 14 May 2019 (Figure 1 and Table 1). A new case was also reported in the health zone of Alimbongo this week with links to cases deriving from Katwa.

Current transmission patterns also illustrate the challenges resulting from cases originating from hotpot health zones and re-introducing the virus to areas where transmissions have previously been successfully halted. During this period, new cases were reported from 91 health areas within 18 of the 22 health zones affected to date (Figure 2).

As of 14 May, a total of 1739 confirmed and probable EVD cases have been reported, of which 1147 died (case fatality ratio 66%). Of the total cases with recorded sex and age, 56% (974) were female and 30% (514) were children aged less than 18 years. The number of healthcare workers affected has risen to 102 (6% of total cases). Of the EVD patients who received care at ETCs, 459 have been successfully discharged.

Risk communication and community engagement teams continue to spread messages about the importance of seeking care early at healthcare facilities for an increased chance of survival. These messages have been particularly effective in Beni, where affected individuals have been reporting to the ETCs more frequently and more rapidly after onset of symptoms.

The risk communication and community engagement actors have been instrumental in mediating instances of reluctance and resistance at the community level to ensure peaceful agreements are reached and that other pillars of the response such as vaccination, infection prevention and control (IPC), and safe and dignified burials (SDB) are able to carry out their respective response activities.

It is anticipated that the rising case figures will continue within the hotspot areas in the coming weeks given the resumption of most major response activities, which will lead to the detection of more cases. The increased transmission rates witnessed recently continue to demonstrate a heightened risk of EVD spreading to other neighbouring provinces in the Democratic Republic of the Congo, and to surrounding countries.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Monday, May 13, 2019

The epidemiological situation of the Ebola Virus Disease dated May 12, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,705, of which 1,617 are confirmed and 88 are probable. In total, there were 1,124 deaths (1,036 confirmed and 88 probable) and 456 people healed.

• 251 suspected cases under investigation;

• 25 new confirmed cases, including 10 in Kalunguta, 7 in Mabalako, 3 in Katwa, 2 in Butembo, 1 in Mangurujipa, 1 in Musienene and 1 in Kyondo;

• 7 new confirmed case deaths, including

º 5 community deaths, 2 in Mabalako, 2 in Butembo and 1 in Kalunguta;

º 2 deaths at CTE, including 1 in Butembo and 1 in Mabalako;

• 6 new healings from ETCs, including 5 in Mabalako and 1 in Katwa;

• Two unvaccinated health workers (one in Mabalako and one in Kalunguta) are among the new confirmed cases.

º The cumulative number of confirmed / probable cases among health workers is 101 (5.9% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

Security situation

• One person died during a militia assault on the Ebola Treatment Center in Katwa on Monday, May 13, 2019 around one in the morning. Butembo Mayor Sylvain Mbusa Kanyamanda says he is an assailant who was killed by the defense and security forces. The urban authority reassured that no material damage was recorded.

FIGURES OF THE RESPONSE

114,553 Vaccinated persons

• 486 people vaccinated on 12/05/2019.

• Of those vaccinated, 30,816 are high-risk contacts (CHRs), 55,294 are contacts of contacts (CC), and 28,443 are front-line providers (PPLs).

• Persons vaccinated by health zone: 30,886 in Katwa, 24,064 in Beni, 14,006 in Butembo, 7,730 in Mabalako, 5,803 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,954 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,472 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Saturday, May 11, 2019

The epidemiological situation of the Ebola Virus Disease dated May 10, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,662, of which 1,574 confirmed and 88 probable. In total, there were 1,112 deaths (1,024 confirmed and 88 probable) and 446 people healed.

• 325 suspected cases under investigation;

• 13 new confirmed cases, including 5 in Butembo, 2 in Kalunguta, 2 in Mandima, 1 in Musienene, 1 in Mabalako, 1 in Katwa and 1 in Masereka;

• 7 new confirmed case deaths, including

º 6 community deaths, including 3 in Butembo, 2 in Kalunguta and 1 in Katwa;

º 1 death at the CTE of Mabalako;

• 2 new cures out of ETCs, including 1 in Butembo and 1 in Beni;

• 1 non-vaccinated Butembo health worker is one of the new confirmed cases.

º The cumulative number of confirmed/probable cases among health workers is 98 (5.9% of all confirmed/probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Visit of the Acting Governor of North Kivu to Butembo

• The Acting Governor of North Kivu, Maître Feller Lutaichirwa, arrived in Butembo on Friday, May 10, 2019 with an inter-institutional delegation composed of the Provincial Security Committee and members of the North Kivu Provincial Assembly to conduct an assessment mission. of the security situation.

• They began their visit with a hearing with the Ebola response coordinators on Friday. This Saturday, May 11, 2019, a social dialogue was organized between the provincial authorities and the representatives of the different social strata of the city of Butembo in the meeting hall of the town hall. Discussions focused on security and health issues. Several people took the floor, such as the president of the Butembo-Lubero Congolese Business Federation (FEC), the first vice-president of the Civil Society Provincial Coordination of North Kivu and journalists.

• Butembo's response coordinator Dr Justus Nsio took the opportunity to explain the evolution of the epidemic in the city before reminding them of the importance of rapid medical care. The social dialogue closed with a firm commitment from the different sections of the population of Butembo to take ownership of the response and accept the instructions of doctors to fight against Ebola. The Interim Governor announced a high-level meeting in Kinshasa to adopt new security measures in Butembo and surrounding areas.

FIGURES OF THE RESPONSE

113,667 Vaccinated persons

• 550 people vaccinated on 10/05/2019.

• Among the vaccinated persons, 30,484 are high-risk contacts (CHR), 54,771 are contacts of contacts (CC), and 28,412 are first-line providers (PPL).

• Persons vaccinated by health zone: 30,546 in Katwa, 23,888 in Beni, 13,803 in Butembo, 7,614 in Mabalako, 5,778 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,928 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,472 to Lubero, 1,487 to Bunia, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

EVOLUTION OF THE EBOLA EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI

Thursday 9 May 2019

The epidemiological situation of the Ebola Virus Disease dated 8 May 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,604, of which 1,538 are confirmed and 66 are probable. In total, there were 1,074 deaths (1,008 confirmed and 66 probable) and 442 people healed.

• 264 suspected cases under investigation;

• 4 new confirmed cases, including 3 in Mabalako and 1 in Beni;

• 5 new deaths of confirmed cases, including

º 3 community deaths, 2 in Mabalako and 1 in Beni;

º 2 deaths at CTE Mabalako.

/! \ Paralysis of the activities of the Butembo sub-coordination on Wednesday, May 8, 2019.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

NEWS

Nothing to report

Security situation

• Butembo's sub-coordination teams partially returned to work on Thursday, May 9, 2019. However, some health areas in Butembo town remained inaccessible for security reasons.

FIGURES OF THE RESPONSE

112,762 vaccinated persons

• 277 people vaccinated on the 08/05/2019.

• Of the 112,762 people vaccinated, 30,123 are high-risk contacts (CHR), 54,260 are contacts of contacts (CC), and 28,739 are front-line providers (PPL).

• Persons vaccinated by health zone: 30,432 in Katwa, 23,789 in Beni, 13,803 in Butembo, 7,322 in Mabalako, 5,487 in Mandima, 3,608 in Kalunguta, 3,070 in Goma, 2,879 in Komanda, 2,569 in Oicha, 1,980 in Kayna, 1,930 in Masereka , 1,915 to Vuhovi, 1,748 to Kyondo, 1,487 to Bunia, 1,412 to Lubero, 1,357 to Karisimbi, 1,197 to Musienene, 1,025 to Biena, 1,012 to Mutwanga, 690 to Rutshuru, 557 to Rwampara (Ituri), 527 to Nyankunde, 496 to Mangurujipa, 420 in Mambasa, 355 in Tchomia, 342 in Kirotshe, 333 in Lolwa, 254 in Alimbongo, 250 in Mweso, 245 in Kibirizi, 161 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

Health control checkpoints

56,294,541 people under control

• 80 entry points (PoE) and operational health checkpoints (PoC).

• 239,339 travelers went to checkpoints and entry points on 08/05/2019.

• 888 refused sanitary control (0.4%).

Infected healthcare workers

97

• The cumulative number of confirmed/probable cases among health workers is 97 (6% of all confirmed/probable cases), including 34 deaths.

The epidemiological situation of the Ebola Virus Disease dated May 7, 2019:

• Since the beginning of the epidemic, the cumulative number of cases is 1,600, of which 1,534 are confirmed and 66 are probable. In total, there were 1,069 deaths (1,003 confirmed and 66 probable) and 442 people healed.

• 267 suspected cases under investigation;

• 15 new confirmed cases, including 5 in Katwa, 4 in Kalunguta, 4 in Mabalako, 1 in Mandima and 1 in Musienene;

• 14 new confirmed case deaths, including

º 10 community / hospital deaths including 4 in Kalunguta, 4 in Mabalako, 1 in Katwa and 1 in Musienene;

º 4 CTE / CT deaths, 2 in Mabalako, 1 in Katwa and 1 in Butembo;

• 1 new healed patient from Mabalako CTE;

• Two Katwa health workers, including one vaccinated, are among the new confirmed cases.

º The cumulative number of confirmed / probable cases among health workers is 97 (6% of all confirmed / probable cases), including 34 deaths.

/! \ The data presented in this table are subject to change later, after extensive investigations and after redistribution of cases and deaths in their health areas.

News of the response

Security situation

Armed men launched several attacks in the town of Butembo on Wednesday, May 8, 2019 around 5:30 am. The attackers were repulsed by the Armed Forces of the Democratic Republic of Congo (FARDC). A dozen attackers were killed and six were captured. A policeman from the city also died in the attack. Because of this new security incident, the response teams have limited their movements in the city. Only a minimum service was performed. Since the beginning of May, this is the fifth consecutive day in which the response teams have not been able to carry out all the necessary response activities in Butembo, such as active case finding in the community, vaccination and dignified and secure burials.

• The triage of the Masiki Health Center in Katwa Health Zone was set on fire on Tuesday, May 7, 2019.

• A dignified and secure burial team officer was murdered in Vuhovi on the night of May 7 to 8, 2019. It was in this health zone that the nurse in charge of the Isonga health area had been kidnapped and killed in February 2019.

Vaccination

• Since the beginning of the vaccination August 8, 2018, 112 485 p eople have been vaccinated , of which, 30,432 in Katwa, 23,752 in Beni, 13 803 in Butembo, 7202 at Mabalako, 5407 at Mandima 3608 to Kalunguta, 3070 in Goma, 2879 to Komanda, 2569 at Oicha, 1980 in Kayna, 1930 to Masereka, 1915 at Vuhovi, 1748 at Kyondo, 1487 in Bunia, 1372 in Lubero, 1357 at Karisimbi, 1197 at Musienene, 1025 at Biena, 1012 at Mutwanga, 690 in Rutshuru, 557 Rwampara (Ituri), 527 to Nyankunde 496 to Mangurujipa, 420 Mambasa 355 for Tchomia 342 to Kirotshe, 333 to Lolwa, 254 to Alimbongo, 250 to Mweso, 245 to Kibirizi 161 to Nyiragongo 97 Watsa (Haut-Uélé) and 13 in Kisangani.

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.